Issues to Be Addressed in Treatment (Adults and Juveniles):
(1) Arousal or Impulse Control. Control of deviant arousal, fantasies, and impulses should be a priority in treating adult sex offenders and juveniles with sexual behavior problems. Arousal or impulse control may require periodic "follow up" sessions for the duration of a client's life. Effective arousal or impulse control shall include methods to control spontaneous deviant fantasies and to minimize contact with objects or persons within the deviant fantasies. Arousal or impulse control should proceed from the most effective methods to less effective methods.
(2) Cognitive Behavioral Treatment. Cognitive behavioral treatment shall identify, assess, and modify cognitions that promote sexual deviance. Cognitive distortions shall be addressed and include the thoughts and attitudes that allow offenders to justify, rationalize, and minimize the impact of their deviant behavior.
(3) Sexual Offense Sequence/Reoffense Prevention. Treatment shall address the sequence of behaviors, emotions, and cognitions which are identifiable and which precede deviant sexual behavior in a predictable manner. Autobiographies, sexual history polygraphs, offense reports, interviews and cognitive-behavioral chains shall be used to identify antecedents to offending. Treatment shall include a formal multi-level reoffense prevention plan to address the multiple issues in reducing recidivism.
(4) Victim Empathy. Treatment shall focus on highlighting the consequences of victimization and sensitize the offender to the harm he or she has committed. Treatment providers should utilize analogous experiences when treating juveniles and should recognize that cognitive development impacts the ability to empathize.
(5) Biomedical Approaches. Psychopharmacological agents should only be utilized in select cases. Use of these agents shall never be the only method of treatment. Physical or chemical castration shall be utilized only as an adjunct to treatment and not in lieu of treatment.
(6) Increasing Social Competence. Treatment should include, but not be limited to, improving interpersonal communication skills, problem solving, assertiveness, and developing and sustaining reciprocal pro-social friendships and social support networks. Treatment shall assist in the clients' ability to deal effectively with social situations and develop meaningful relationships with others.
(7) Chaperones. Licensees shall assist in the selection and education of the potential chaperones for contacts between the adult client and children. Potential chaperones shall only be adults who accept and understand the client's present sexual offense, past sexual offending, and the potential for sexual re-offense. Licensees shall ensure potential chaperones are educated regarding the client's sexual history, treatment and supervision conditions, antecedents to sexual offending, safety plans, reoffense prevention plans, and reporting procedures. Licensees shall review a detailed safety plan with the child's non-offending parent or legal guardian that describes the appropriate levels of supervision for contact, privacy, discipline practice, sexual education, appropriate dress, hygiene, bedtime routines, conditions and limits that may apply, and how contact will be terminated if it is no longer appropriate for the child.
(8) Improving Primary Relationships. Treatment providers should involve the current partners or family members in treatment to assist the client in developing a functional lifestyle and maintain reciprocal relationships with an appropriate partner. Treatment providers should involve family members in treatment and address with juveniles sex education needs, appropriate dating skills, and relationship skills.
(9) Co-morbid Diagnosis. Treatment provider should make appropriate referral when there are sufficient signs and symptoms to merit additional diagnosis criteria. The most common are substance abuse and affective disorders. The co-morbid diagnosis shall be treated with the appropriate therapies concomitantly with the treatment for sex offending behavior except in the case of schizophrenia where the anti-psychotic therapy would take precedence.
(10) Couples/Family Therapy. Individual, couple, family, and sibling therapy, non-offending spouse groups, and/or parents or legal guardians of victims' groups shall prepare the partner and family for the issues and methods involved in sex offender treatment. A predetermined integration sequence shall be followed which addresses role and boundary issues if the client is to reside with victims or children. This shall include close supervision and a multitude of safeguards for the protection of children.
(11) Support Systems. Social support networks should assist the adult sex offender and juvenile in avoiding and coping with antecedents to sexual deviance and address the issues related to risk. The support system shall include individuals from the adult sex offender and juvenile's daily life (for example: family, extended family, guardian, custodian, friends, co-workers, and church members).
(12) Adjunct Therapies. Adjunct therapy may include, but is not limited to, substance abuse, anger management, stress management, social skills, sex education, or self-help groups, and shall primarily be used as adjuncts to a comprehensive treatment program in reducing the client's risk to re-offend. Other licensed mental health professionals may conduct adjunct therapies.
(13) After-Care Treatment. After-care treatment shall involve periodic "follow up" sessions to reinforce and assess maintenance of positive gains made during treatment. After-care treatment can be facilitated by involving the treatment group, supervision personnel, support system, the use of polygraphs, phallometric assessment, and visual reaction time assessment.